What are the symptoms of ovarian masses?

A woman's ovaries are like a funnel, hanging on the human body. Next to the ovaries is the uterus, and around the uterus are appendages connected to multiple organs. The ovaries can cause tumors and cysts, including various complications. Most people will be told by the doctor that they have ovarian masses when they have a physical examination in the hospital. Ovarian masses, commonly known as ovarian cysts, are malignant ovarian tumors. They are very small at first, and eventually spread to multiple organs in the body, causing complications of the disease.

1. What are the characteristics of ovarian tumors?

1. Ovarian tumors are common gynecological tumors that can occur at all ages, but the histological types of the tumors may vary. Epithelial ovarian tumors are more common in women aged 50-60 years, while ovarian germ cell tumors are more common in young women under 30 years old. Ovarian malignancy is one of the three most common malignant tumors of the female reproductive system.

2. The ovaries are located deep in the pelvic cavity, and early lesions are difficult to detect. Once symptoms appear, they are mostly in the late stage, so you should be highly vigilant. In the past 20 years, the application of effective chemotherapy regimens has significantly improved the treatment effect of malignant germ cell tumors, and the mortality rate has dropped from 90% to 10%; however, the treatment effect of malignant epithelial ovarian tumors has not improved, and the 5-year survival rate hovers around 30%-40%, with the mortality rate ranking first among gynecological malignant tumors. Malignant epithelial ovarian tumors have become a major tumor that seriously threatens women's life and health.

3. Although the ovaries are small and have complex tissues, they are the part of the body with the most tumor types. Ovarian tumors have many histological types and can be benign, borderline, and malignant. The ovary is also a common metastatic site for gastrointestinal malignancies, breast cancer, and endometrial cancer.

2. How are ovarian tumors classified histologically?

1. Epithelial tumors

It accounts for 50%-70% of primary ovarian tumors, and its malignant type accounts for 85%-90% of ovarian malignant tumors. It originates from the germinal epithelium on the surface of the ovary, which in turn originates from the primitive coelomic epithelium and has the potential to differentiate into various Müllerian epithelia. If it differentiates into the fallopian tube epithelium, it forms a serous tumor; if it differentiates into the cervical mucosa, it forms a mucinous tumor; if it differentiates into the endometrium, it forms an endometrioid tumor.

2. Germ cell tumors

It accounts for 20%-40% of ovarian tumors. Germ cells originate from endoderm tissue outside the gonads, and can mutate and form tumors during their occurrence, migration, and development. Germ cells have the function of giving rise to a variety of tissues. Undifferentiated ones are dysgerminomas, those that differentiate into embryonic pluripotent ones are embryonal carcinomas, those that differentiate into embryonic structures are teratomas, and those that differentiate into extraembryonic structures are endodermal sinus tumors and choriocarcinomas.

3. Sex cord-stromal tumors

It accounts for about 5% of ovarian tumors. The sex cord stroma originates from the mesenchyme of the primitive body cavity and can differentiate into male and female. The sex cords differentiate into epithelial cells to form granulosa cell tumors or supporting cell tumors; they differentiate into mesenchymal cells to form theca cell tumors or interstitial cell tumors. This type of tumor often has endocrine function, so it is also called functional ovarian tumor.

4. Metastatic tumors

It accounts for 5%-10% of ovarian tumors, and its primary sites are mostly the gastrointestinal tract, breast and reproductive organs.

How to treat ovarian tumors?

1. If the diameter of the mass is less than 5 cm, it is suspected to be an ovarian tumor-like lesion and can be observed for a short period of time.

2. Once an ovarian tumor is diagnosed, surgical treatment should be performed. The surgical method and scope are determined based on the patient's age, whether or not they want to have children, and the condition of the contralateral ovary.

Young patients with fertility desires who have unilateral benign tumors should undergo ovarian cystectomy or oophorectomy on the affected side, and preserve normal ovarian tissue and the contralateral normal ovary as much as possible. Even if there are bilateral benign cysts, cystectomy should be performed to preserve normal ovarian tissue and the endocrine and reproductive functions of the ovaries. The retained ovarian tissue is still likely to develop pathological changes like normal ovaries.